Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $119.54 / $119.54 / $119.54	Facility	26	$119.54	$119.54	$119.54
Aetna Facility/Professional Professional Modifier Low / Median / High Price $101.04 / $123.53 / $373.53	Professional		$101.04	$123.53	$373.53
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.91 / $34.93 / $154.93	Professional	26	$29.91	$34.93	$154.93
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $71.14 / $88.59 / $241.87	Professional	TC	$71.14	$88.59	$241.87
Cigna Facility/Professional Professional Modifier Low / Median / High Price $181.47 / $314.26 / $448.63	Professional		$181.47	$314.26	$448.63
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $57.89 / $106.55 / $141.51	Professional	26	$57.89	$106.55	$141.51
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $123.58 / $207.71 / $317.89	Professional	TC	$123.58	$207.71	$317.89
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $292.73 / $351.27 / $772.37	Professional		$292.73	$351.27	$772.37
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $92.20 / $112.66 / $327.14	Professional	26	$92.20	$112.66	$327.14
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $190.43 / $240.66 / $585.65	Professional	TC	$190.43	$240.66	$585.65
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $431.25 / $496.80 / $757.67	Professional		$431.25	$496.80	$757.67
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $123.75 / $153.90 / $247.50	Professional	26	$123.75	$153.90	$247.50
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $307.50 / $344.25 / $510.18	Professional	TC	$307.50	$344.25	$510.18
Providence Facility/Professional Professional Modifier Low / Median / High Price $163.88 / $431.25 / $747.30	Professional		$163.88	$431.25	$747.30
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $99.00 / $172.50 / $247.50	Professional	26	$99.00	$172.50	$247.50
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $225.54 / $336.00 / $510.18	Professional	TC	$225.54	$336.00	$510.18
United Facility/Professional Professional Modifier Low / Median / High Price $122.34 / $305.50 / $738.17	Professional		$122.34	$305.50	$738.17
United Facility/Professional Professional Modifier 26 Low / Median / High Price $46.70 / $117.78 / $268.02	Professional	26	$46.70	$117.78	$268.02
United Facility/Professional Professional Modifier TC Low / Median / High Price $97.63 / $187.72 / $453.60	Professional	TC	$97.63	$187.72	$453.60